Tag Archives: trauma

Do you know your ABCDDE of burns management?

With thanks to Dr Cate Luce:

Here is a systematic approach to burns using an ABCDE approach.

A: Is their airway compromised?

Consider in:

  • Facial burns
  • Smoke Inhalation
  • Dyspnoea
  • Hoarseness
  • Drooling
  • Stridor, wheeze, crepitations
  • Increase work of breathing

For more information: https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/ 1

B: Basic first aid 

Adequate pain relief is essential in burns. You should use something fast-acting such as intranasal diamorphine or follow your local policy. This will allow for a better assessment of the extent of the burns and delivery of basic first aid. Don’t forget running cold water on the affected area for at least 20 minutes, which may be effective up to 3 hours after the burn.

C: Calculate the percentage of total body surface area (TBSA)

There are several methods to calculate the percentage of TBSA. The palmar aspect of a child’s hand is 1% of a child’s surface area. You can use the Lund and Browder charts.

https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts 2

People often overestimate the percentage of TBSA affected; remember to only include partial and full thickness burns as defined at www.cks.nhs.uk/burns_and_scalds3.

Why not make it easy for yourself and download the Mersey Burns App4, which calculates the percentage of burns for you?

Children with more than 10% of TBSA will need intravenous fluids. The app also calculates the fluid required using the Parkland Formula (3-4ml x (%TBSA) x (weight kg)). You should give half in the first 8 hours followed by the rest within the next 16hours.

D: Discussion with burns centre

  • >5%
  • Chemical/electrical/high pressure steam
  • Face/hands/feet/perineum/flexures/circumferential
  • Inhalation
  • Serious co-morbidity
  • Non accidental

D: Disabilities– what are the complications?

E: External factors 

Burns can be a result of neglect or physical abuse therefore safeguarding should always be considered. Use the Child Protection Companion as a guide.

https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf 6

Always check the child’s immunisation status, especially tetanus, as burns can act as a tetanus-prone wound.

 

References

  1. Davis, T. PICU Q+A: airway injuries due to burns, Don’t Forget the Bubbles, 2013.https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/
  2. Sillett, Remember, Remember Burns and Scalds, https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts
  3. NICE, Burns and Scalds 2019, cks.nhs.uk/burns_and_scalds.
  4. https://app.merseyburns.com/
  5. Toxic Shock Syndrome 2019, https://www.nhs.uk/conditions/toxic-shock-syndrome/
  6. Child Protection Evidence, Systemic review of burns, July 2019, https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf

 

February’s newsletter 2018

What constitutes sexualised behaviour in a 4 year old?  This and the childhood asthma control test, this month, toddler fractures and the PCV vaccine.  Do leave comments below.

March 2016 uploaded

March 2016: a few odds and ends on asthma this month and assessing a child in an acute exacerbation, Childline survey, Meningococcus W and paediatric neck lumps.  Do leave comments below:

April and May!

I seem to have forgotten to put a blog post up when I published April’s newsletter which contains information on: tonsillectomy for parents, erythema infectiosum (which I think my son had this week), a safety alert about bath seats, tranexamic acid in paediatric trauma and how to make a nasal douche for rhinitis sufferers.

May is now also published and features dangerous dogs, knee pain, dental caries and continuations of both the dermatology and ENT features.  Do leave comments below.

March 2014 newsletter

March brings urticaria, headaches, rugby injuries, Severs disease and bruising.  Do leave comments below:

February 2014 uploaded

Scabies this month with a beautiful picture of plantar lesions in a child.  Updated NICE head injuries, antipyretics (or not) for febrile convulsions, child trafficking and the last in the sleep series.  Do leave comments below.

August 2013 PDF published

Thermal injuries from a safeguarding point of view this month, updated fever guidelines, quarantine periods for infectious diseases, house dust mite allergy and facial injuries this month as the last in the minor injuries series.  Do leave comments below.

July 2013 PDF

Neglect and emotional abuse is the safeguarding topic this month.  ED advice on the management of minor head injuries, a report from BPSU in hypocalcaemic fits secondary to vitamin D deficiency, the new UK immunisation poster and a bit on crying babies.  Hope you find it all helpful.  Comments welcome below

June 2013 ready to go!

Lots of things to talk about this month.  Reminder of what Koplik spots look like, good e-learning on human trafficking, a link to the new primary care guidelines page, night terrors v. nightmares, some good allergy websites and Jess Spedding again on scaphoid injuries.  Do leave comments below.

April/May 2013

April wasn’t quite long enough this year for me to get the newsletter out in time – or something like that anyway.  With thanks to Stephen Flanagan of the London PHE for his input into the measles textbox and Paul Gringras for help with the sleep series again.  Jess has put together another superb article for her minor injuries series and I hope you find the links to the healthy weight clinics helpful for your patients locally.  Click here for the April/May 2013 newsletter.